Method and apparatus for monitoring blood constituent levels in biological tissue

ABSTRACT

In accordance with the invention, a low coherence interferometer is used to non-invasively monitor the concentration of glucose in blood by shining a light over a surface area of human or animal tissue, continuously scanning the light over a two dimensional area of the surface, collecting the reflected light from within the tissue and constructively interfering this reflected light with light reflected along a reference path to scan the tissue in depth. Since the reflection spectrum is sensitive to glucose concentration at particular wavelengths, measurement and analysis of the reflected light provides a measure of the level of glucose in the blood. The measurement of glucose is taken from multiple depths within blood-profused tissue, and sensitivity is preferably enhanced by the use of multiple wavelengths. Noise or speckle associated with this technique is minimized by continuously scanning the illuminated tissue in area and depth.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application of a pending U.S. patent application bearing Ser. No. 10/916,236, filed Aug. 11, 2004. The pending patent application is hereby incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

This invention pertains to methods and apparatus for monitoring the blood glucose level in biological tissues. It is especially useful for non-invasive monitoring of blood glucose in human or animal diabetics. Specifically, it relates to methods and apparatus for non-invasive monitoring of blood glucose using optical coherence interferometry with continuous area scanning and simultaneous depth scanning to reduce the effect of speckle (noise).

BACKGROUND OF THE INVENTION

Monitoring of blood glucose (blood sugar) concentration levels has long been critical to the treatment of diabetes in humans. Current blood glucose monitors involve a chemical reaction between blood serum and a test strip, requiring an invasive extraction of blood via a lancet or pinprick. Small handheld monitors have been developed to enable a patient to perform this procedure anywhere, at any time. But the inconvenience of this procedure—specifically the blood extraction and the use and disposition of test strips—has led to a low level of compliance. Such low compliance can lead to serious medical complications. Thus, a non-invasive method for monitoring blood glucose is needed.

Studies have shown that optical methods can detect small changes in biological tissue scattering related to changes in levels of blood sugar. Although highly complex, a first order approximation of monochromatic light scattered by biological tissue can be described by the following simplified equation: I _(R) =I _(O)exp[−(μ_(a)+μ_(S))L] where I_(R) is the intensity of light reflected from the skin, I_(O) is the intensity of the light illuminating the skin, μ_(a) is the absorption coefficient of the skin at the specific wavelength of light, μ_(S) is the scatter coefficient of the skin at the specific wavelength of light, and L is the total path traversed by the light. From this relationship it can be seen that the intensity of the light decays exponentially as either the absorption or the scattering of the tissue increases.

It is well established that there is a difference in the index of refraction between blood serum/interstitial fluid (blood/IF) and membranes of cells such as blood cells and skin cells. (See, R. C. Weast, ed., CRC Handbook of Chemistry and Physics, 70th ed., (CRC Cleveland, OH 1989)). This difference can produce characteristic scattering of transmitted light. Glucose, in its varying forms, is a major constituent of blood/IF. The variation of glucose levels in blood/IF changes its refractive index and thus, the characteristic scattering from blood-profused tissue. In the near infrared wavelength range (NIR), blood glucose changes the scattering coefficient more than it changes the absorption coefficient. Thus, the optical scattering of the blood/IF and cell mixture varies as the blood glucose level changes. Accordingly, an optical method has potential for non-invasive measurement of blood glucose concentration.

Non-invasive optical techniques being explored for blood glucose application include polarimetry, Raman spectroscopy, near-infrared absorption, scattering spectroscopy, photoacoustics and optoacoustics. Despite significant efforts, these techniques have shortcomings such as low sensitivity, low accuracy (less than current invasive home monitors) and insufficient specificity of glucose concentration measurement within the relevant physiological range (4-30 mM or 72-540 mg/dL). Accordingly, there is a need for an improved method to non-invasively monitor glucose.

Optical coherence tomography, or OCT, is an optical imaging technique using light waves that produces high resolution imagery of biological tissue. OCT creates its images by interferometrically scanning in depth a linear succession of spots, and measuring absorption and/or scattering at different depths in each successive spot. The data is then processed to present an image of the linear cross section. It has been proposed that OCT might be useful in measuring blood glucose.

There are, however, major drawbacks to the use of OCT for glucose monitoring. First, the OCT process requires lengthy scanning to reduce optical noise (“speckle”). Speckle arises from wavefront distortion, when coherent light scatters from tissue. OCT seeks to minimize speckle by averaging it out over many measurements. However this approach in OCT requires a time period impractically long for a home monitor, and even then speckle in OCT remains problematic for achieving a sufficiently accurate measurement of glucose level.

A second drawback of OCT is that it requires complex processing to form an image and even further processing to analyze the image data to determine glucose levels.

A third drawback is that OCT requires expensive, bulky, precision equipment neither suitable for transport or for use outside the laboratory. Accordingly, there is a need for an improved methods and apparatus for non-invasive blood glucose monitoring.

SUMMARY OF THE INVENTION

In accordance with the invention, the blood glucose concentration within a biological tissue is monitored by providing light having scattering properties sensitive to the glucose concentration within the tissue and continuously scanning the light over a two dimensional area of the tissue while, at the same time, interferometrically scanning the tissue in depth. The light reflected from the scanned tissue is collected and analyzed to determine the concentration of glucose in the tissue. In an advantageous embodiment light from one or more sources is split into a sample beam and a reference beam. The sample beam is continuously scanned over the surface and the phase of the reference beam is varied and interfered with the reflected light to effect interferometric depth scanning. In a preferred embodiment, the light provided is composed of at least two different wavelengths having measurably different scattering properties for glucose-containing tissue or biological indicators of such tissue.

An apparatus for measuring the blood glucose level in biological tissue comprises one or more light sources to provide light. Optical fiber or lens-directed paths direct the light onto the tissue, an area scanner continuously scans the light over a two-dimensional area of the tissue and an interferometer effectively scans the tissue in depth. The interferometer also collects, analyzes and measures the light reflected within the tissue. A processor responsive to the light measurements then calculates the glucose level of blood-profused regions of the tissue. Advantageously, the apparatus uses low coherence light sources (light emitting diodes (LEDs) or super luminescent diodes (SLEDs), a low coherence interferometer (LCI), and beam focusing optics. The continuous scanning over a two-dimensional area and the depth scanning reduce noise or speckle and optimize the amount of blood-profused tissue scanned.

BRIEF DESCRIPTION OF THE FIGURES

The advantages, nature and various additional features of the invention will appear more fully upon consideration of the illustrative embodiments now to be described in detail in connection with the accompanying drawings. In the drawings:

FIGS. 1 a and 1 b illustrate the anatomy of the skin and the resulting OCT signal;

FIGS. 2 a and 2 b graphically represent the data collected from an OCT signal and blood measurements and the correlation between the two;

FIG. 3 is a schematic diagram illustrating a method of blood glucose monitoring in accordance with the invention;

FIG. 4 schematically illustrates an apparatus useful for practicing the method of FIG. 3;

It is to be understood that the drawings are for the purpose of illustrating the concepts of the invention, and except for the graphs, are not to scale.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 a is a schematic cross section of the skin showing the skin surface 1, the epidermis layer 2 and the dermis layer 3. Various additional structures are labeled. Some structures, such as hair and its associated follicles, scatter light in a manner unrelated to glucose concentration. Other regions, such as regions in the dermis near the capillaries are profused with blood and IF (blood profused tissues) and light scattered from these regions is highly correlated with glucose concentration.

FIG. 1 b graphically illustrates light scattered within the skin as a function of depth. Region 1 of the curve corresponds to light reflected from the skin surface. Region 2 shows light scattered within the epidermis, and Region 3 is light scattered from the dermis. As we will show, slope of the curve at depths where the tissue is profused with blood (e.g. near the capillaries) is highly correlated with blood glucose levels.

FIG. 2 a graphically plots the slope of the optical signal reflected by blood-profused tissue (the continuous line) and the measured blood glucose concentration (rectangular dots) as a function of time after a human subject ingests a glucose drink. As can be seen, the slope of the reflected signal closely follows the glucose concentration.

FIG. 2 b illustrates the best-fit linear relation between the slope of the reflected optical signal in FIG. 2 a with the measured blood glucose concentration. As can be seen, the slope of the reflected light in regions of blood-profused tissue is highly correlated with glucose concentration. These data show a 0.95 correlation.

Applicant has determined that the information contained in scattered optical signals can be used to measure glucose concentration without creating and analyzing images. At a wavelength of around 1.3 μm, the scattering coefficient, μ_(S), is several times larger than the absorption coefficient, μ_(a), and a simple linear fit to the logarithmic data will yield the scattering coefficients within the dermis layer. For blood-profused regions, this scattering coefficient can be related to glucose concentration changes within the blood.

A non-invasive glucose monitor ideally overcomes three problems. First, the speckle (noise) should be overcome within a reasonable test time. Second, the effect of tissues other than blood-profused tissues should be minimized, and third, as much blood-profused tissue as possible should be analyzed. Applicant addresses these problems by continuously scanning a two-dimensional area of the tissue to be monitored (preferably the skin) while at the same time interferometrically scanning to different depths. The area scanning optionally combined with the multiple level depth scanning permits measurement of many different localized areas of blood-profused tissue, minimizing the effect of speckle. Preferably, the light comprises at least two different wavelengths of light having measurably different absorption and scattering properties for glucose, blood, or other biological indicators of blood-profused tissues. The two different wavelengths permit identification of which measurements are of blood-profused tissues.

In some respects, the invention can be thought of as a modification of OCT from an imaging technique to a non-imaging technique. Since no image is formed, the collection optics and data processing are greatly simplified. In addition, the surface scanning is changed from stepwise linear scanning to continuous or near continuous two dimensional area scanning to more rapidly and effectively reduce speckle.

Adapting an OCT system to blood glucose sensing, instead of imaging, provides non-invasive glucose concentration monitoring of a human or animal subject, because the scattered optical signal data can be collected and processed more easily and the resulting data can be correlated linearly to the level of glucose. Additionally, continuous scanning of the incident light beam over a two-dimensional area on the skin surface, instead of the conventional one-dimensional straight line, markedly improves. signal stability while dramatically reducing the noise associated with tissue inhomogeneity. Advantageously an area in the general shape of a circle is scanned.

More specifically, the invention uses interferometry, preferably low coherence interferometry (LCI), to measure the glucose concentration of human or animal blood-profused tissue. LCI can be effected with convenient low coherence light sources and provides advantageously small volumes of constructive interference (“regions of optical interaction”) that can be used to localize readings to blood profused tissue. Beam focusing can be used to further localize the regions of optical interaction. LCI uses a standard interferometer illuminated by low coherence light sources. The interferometer can be any one of the standard forms, e.g. Michaelson, Mach-Zehnder, or the like. The light sources can be LEDs or SLEDs.

The invention is advantageously directed to measure the blood glucose concentration from tissue located in the dermis layer of the skin (3 of FIGS. 1 a and 1 b). In this layer, the rate at which the light intensity decays is a function of the scattering and absorption coefficients, μ_(S) and μ_(a), respectively. The location of the blood profused tissue in the skin varies from subject to subject. It is often found just below the dermis/epidermis junction (100-350 microns depth) and in a deep region below the skin surface (greater then 600 microns).

With low coherence sources, the interferogram is generated over a small volume whose position in the depth of the object can be determined via the phase of a reference beam. This, in turn, can be controlled by a phase shifter, such as a movable reference reflector, preferably a mirror. Thus, a high degree of localization of the measured scattering phenomena can be achieved. For example, for a typical light emitting diode (LED) operating at a 1.3 μm wavelength, a depth resolution of 10 μm is easily achieved in biological tissues. Typically in biological tissues, the scatter of the light occurs at the interface between the cell membrane and the fluid that surrounds the cell (i.e. blood or interstitial fluid). Measuring this scatter permits the glucose level to be determined, as by the linear fit shown in FIG. 2 b.

FIG. 3 is a schematic block diagram of the method of measuring the blood glucose concentration on a human or animal subject. The first step, shown in Block A, is to provide light having scattering absorption or properties sensitive to glucose concentration within the tissue. Preferably the light provided comprises at least two different wavelengths. By different wavelengths is meant that the wavelengths should be sufficiently different that they have measurably different absorption and scatter properties for different levels of glucose and/or indicator components such as blood. Typically, the light is provided from multiple single wavelength sources, such as low coherence superluminescent diodes (SLEDs) at wavelengths in the red/near infrared range (RNIR). Alternatively, the light can be provided from a single broadband source appropriately notch filtered. Both wavelengths of light are advantageously directed in a single beam.

The next step, shown in Block B, is to split the single beam of light into a reference beam and a sample beam. The reference beam travels in an adjustable phase path denoted as the reference beam path (reference arm), and the sample beam travels in a sample beam path (sample arm) where it is directed onto the tissue to be monitored, e.g. the skin of a human diabetic. The light in the reference beam is directed over an adjustable phase path and will subsequently be interfered with sample light reflected from within the tissue.

In the third step, Block C, the sample beam is continuously or near continuously scanned over a two-dimensional area of the tissue while, at the same time, being interferometrically scanned in depth. Block D shows varying the phase (path length) of the reference beam so that light from the reference beam constructively interferes with reflected sample light from successively different depths of tissue. Block E shows the reflected light collected and interfered with the reference beam. As the interferometer sweeps in depth, the surface scan is also sweeping continuously. This “smears” out the scan and reduces the effect of speckle.

The next steps, Blocks F, G, and H are to process the resulting data to calculate glucose concentration. In essence, this is achieved by computing the scattering coefficient of glucose-containing tissue. Block F indicates the scanning data is input into a digital processor. Block G, which is optional, but advantageous, is to identify those scattering measurements that are from blood-profused tissue (in or near blood vessels). Such identification can be accomplished, for example, by providing light of two different wavelengths, at least one of which scatters from blood profused tissues in a characteristic manner. Finally, in Block H, the scattering coefficient of the glucose containing tissue is calculated, and the correlated glucose level in blood is determined.

FIG. 4 schematically shows advantageous apparatus 400 for practicing method of FIG. 3. The apparatus 400 comprises a fiber optics based low coherence interferometer (LCI). A 2×2 fiber optic. splitter 401 forms the basic interferometer. An optical input from light sources 406 is split between a sample beam 402 and a reference beam 404. Sample light in beam 402 is continuously scanned across a sample surface by scanner 408. Preferably, the end of the sample beam 402 can contain imaging optics 403 to tailor the spot size according to the area tissue being measured. Reference beam 404 is varied or adjusted in phase as by a moveable mirror 405 which can be vibrated or oscillated to scan depth. Reflected signals from beams 402 and 404 interfere and are presented to photodetector 407 for measurement. Advantageously, imaging optics 403 can provide high coupling efficiency between the optical system and the tissue.

The tissue volume with which the light interacts (referred to as the interaction volume) is determined by the spot size of the imaging optics (surface area) and the coherence length of the light (depth) The reference beam 404 has a scanning reflector 405 (such as a mirror). The reflector 405 of the interferometer determines the phase shift applied to the reference beam 404 and thus, which reflected light from the reference beam 404 will constructively interfere with the reflected sample beam 403. The differences in phase of the beams determines the depth from which scattered light will be measured. This can permit a fixed depth, adjustable depth, or a scan of multiple depths within the tissue. LCI is thus sensitive to the intensity of the reflected light localized in a small volume of tissue. Determination of the depth and interaction volume permits a more accurate selection of regions of blood-profused tissue beneath the skin.

A photodetector 407 (such as a photodiode) can be used to measure the interference of the light from both the sample beam 402 and the reference beam 404. One or more photodetectors 407 may be used along with optical filters (not shown) designed for each of the different wavelength light sources 406 used in the measurement.

Preferably, the imaging optics 403 are beam focusing optics to reduce the beam cross section so as to minimize the region of optical interaction with the tissue. The use of these optics will enhance the selectivity of the signal while also reducing the effect of speckle.

Light passing through turbid biological tissue is subject to wavefront distortion that produces coherent noise or “speckle”. The effect of speckle can be reduced by taking multiple scans from different locations on the tissue and then averaging these scans. This solution is impractical for the typical OCT imaging system, because the vast number of scans needed to reduce speckle would take too long and would produce a severe loss in the resolution of the image. However, for the present invention, the collection optics can be simpler. The present non-imaging system presents a practical solution to reducing coherent noise. Not only does the speckle effect significantly decrease, but the non-imaging system can continuously scan a two-dimensional area of tissue instead of being limited to a single scanning line. Area scans reduce speckle due to the diversity of tissue regions encompassed in the scan. They also maximize the coverage of blood-profused tissue. Thus, coherent noise is also further reduced.

An alternative solution is to use parallel optical processing where multiple spots on the subject tissue are measured together to create “boiling” speckle. Boiling speckle occurs where the sub-spot speckle is changing so quickly that the observed speckle is averaged out by the human eye, or the integration time of the optical receiver. This inventive system may be modified to create boiling speckle by replacing the scanner 408 with either a lenslet array or a diffractive optical element (DOE). If the lenslet or DOE is rapidly translated or rotated about the optical axis at an very high speed, the observed speckle will be averaged out. Additionally, such a system reduces the number of scans required due to the greater variety of speckle detected.

Since glucose is delivered to the interstitial fluid (IF) in skin via blood, determining the scatter coefficient in the dermis layer of the tissue, where blood vessels are plentiful, provides the closest correlation to variations in glucose concentration. Again, an area scan increases the volume of blood-profused tissue measured.

Area scanning could be achieved by a pair of rotating prisms that continuously move a sample beam spot over a circular area of the tissue surface. Advantageously, the spot would move a minimum of one spot diameter for each depth scan. Thus if the beam spot size is 12 microns and the depth scan is at a rate of 20 Hz, then the spot should advantageously be moved at a minimum rate of 240 microns per second and preferably much faster.

Spot diameters are typically in the range from about 10 microns to 100 microns and preferably 20 microns and higher.

The minimum area of the scan is defined by the number of spot diameters needed to move at the minimum depth scan rate. For the 12 micron spot and 20 Hz depth scan, the minimum area that would need scanning is about 2200 square microns, corresponding to a circular area of about 500 micron diameter. More preferably the system would be designed to cover an area corresponding to a diameter of 500 microns to 10,000 microns.

For speckle reduction using the boiling speckle method of noise reduction, the multiple spots would need to be moved quite rapidly. The spot should move at a minimum of one spot diameter in the integration time of the receiver. For individual spot sizes of about 10 microns and an integration time of about 4 microseconds, the spots would need to move at a minimum of 2.4×10⁵ microns/sec.

The light sources 406 can be light emitting diodes (LED) or super luminescent diodes (SLEDs), both of which are semiconductor based light emitters whose wavelengths can be chosen to give the best contrast between absorption and scatter of blood and other biological constituents, such as water. Typically these wavelengths are in the red/near infrared (RNIR) region of the spectrum, however, longer and shorter wavelengths can be used for enhanced sensitivity. For the glucose measurements, two or more light sources are advantageous and can share the same optical paths through the interferometer.

One of the wavelengths can be chosen to have minimum absorption compared to the scattering coefficient for water and blood constituents. If the other wavelength is chosen to have peak absorption for certain biological constituents, then the difference in light attenuation between the two wavelengths can indicate the position in depth of a relevant structure, such as a blood vessel. Light from the two wavelengths is differently absorbed by the different constituents. This differential absorption differentially reduces the intensity of the scattered (reflected) light. Light reflected off the cellular membrane is partially absorbed by the respective constituent for that wavelength. Where the term “light is reflected from the blood” is used, it is understood to refer to light reflected from the cells in and around the blood vessels, and the constituent in the blood absorbs some of the light according to the specific wavelength and glucose level of the blood. These differences in the scattering and absorption properties provide for an optimal correlation between the scattered signal and blood glucose data.

One exemplary application is a first wavelength of about 1310 nm and a second wavelength of about 820-960 nm. A first wavelength of 1310 nm is chosen because the scattering properties of water and blood and blood constituents is at a maximum compared to the absorption properties of these fluids. The second wavelength, 820-960 nm, is chosen because the absorption of light is very high in the presence of hemoglobin, a blood constituent, (compared to the first wavelength). If the signal of the second wavelength were to experience a rapid decrease at a particular depth in the interaction volume, this rapid decrease would indicate the presence of hemoglobin, and hence, the location of blood-profused tissue. It would thus indicate an optimal slope region for the scattering data of the first wavelength to be related to the glucose concentration.

A second example would be a first wavelength of about 1310 nm and a second wavelength of about 1450 nm. At this second wavelength, the scattering coefficients for blood and water are similar to those of the first wavelength. However, the absorption coefficient for water at this second wavelength is exponentially larger than that of the first wavelength. Thus, a differential measurement between these two wavelengths indicates changes in the hydration level of the tissue. Such changes can then be used to indicate an optimal slope region for measuring blood glucose. However, the use of these two specific wavelengths provides an additional benefit of sensor calibration. As the hydration level in the dermis layer varies, the scattering coefficient of the first wavelength may drift, even though the glucose concentration remains static. Thus, by measuring the skin hydration using the second wavelength, this drift can be compensated for and the OCT sensor can maintain calibration.

An exemplary analysis of the data to determine glucose level essentially involves the following steps:

1. Expressing the reflected intensity I_(r) and the incident intensity I_(o) as logarithms, e.g. Ln(I_(r)), Ln(I_(o)).

2. Plotting the logarithmic data in accordance with the scattering equation. Since the data at the 1310 nanometer wavelength is dominated by scattering (with minimal absorption) the logarithmic scattering equation can be approximated by Ln(I _(r))=L _(n)(I _(o))−(μ_(t))(d) Where μ_(t) is the scattering coefficient and d is the depth of the scan.

3. Determining μ_(t) by regression analysis. This can be achieved by a linear regression through the logarithmic data to determine the best fit slope (μ_(t)). Since, however, the glucose concentration is most accurately read in blood/IF, the regression should analysis is preferably selectively applied to those data points whose depth (or two-wavelength scattering characteristics) are indicative of blood/IF. The glucose concentration, as noted in connection with FIG. 2 b above, at such is regions strongly correlated with the scattering coefficient μ_(t) and can readily calibrated to it.

This, or comparable algorithms can be readily implemented in digital processors by those skilled in the art to provide a rapid, non-invasive readout of glucose level.

It is understood that the above-described embodiments are illustrative of only a few of the many possible specific embodiments, which can represent applications of the invention. Numerous and varied other arrangements can be made by those skilled in the art without departing from the spirit and scope of the invention. 

1. A method of monitoring blood constituent concentration within a biological tissue comprising: providing light having scattering properties sensitive to the blood constituent concentration within the biological tissue; directing the light over an area of the biological tissue; causing a reflected portion of the light to interfere with a reference beam; obtaining interferometric, non-image measurements from at least one tissue depth, the non-image measurements including at least scatter measurements of the light; and processing the non-image measurements to determine the blood constituent concentration within the biological tissue.
 2. The method of claim 1 wherein said providing light comprises providing light from one or more sources that is split into a sample beam and the reference beam, and further wherein said directing the light comprises scanning the sample beam over a two-dimensional area, the method further comprising: varying the phase of the reference beam before causing the reflected portion of the light to interfere with the reference beam.
 3. The method of claim 2 further comprising: adjusting the reference beam to constructively interfere with reflected light from a selected depth within the biological tissue.
 4. The method of claim 1 wherein the two-dimensional area is aligned with a skin surface.
 5. The method of claim 1 wherein said directing the light over an area comprises scanning the biological tissue to reduce speckle.
 6. The method of claim 5 further comprising: scanning multiple depths within the biological tissue to reduce speckle.
 7. The method of claim 1 wherein the light comprises low coherence light.
 8. The method of claim 1 wherein the light comprises at least two different wavelengths including a first wavelength having measurably different scattering properties for hemoglobin-containing tissue or indicators of such tissue relative to a second wavelength.
 9. The method of claim 8 wherein the at least two different wavelengths comprise at least one wavelength at about 1310 nm, at about 1450 nm, and in a range from about 820 nm to about 960 nm.
 10. The method of claim 1 wherein the light comprises at least one of infrared light and near infrared light.
 11. The method of claim 1 wherein the reflected portion of the scanned light comprises light reflected from blood-perfused tissue.
 12. The method of claim 1 further comprises: measuring changes in a hydration level of the biological tissue.
 13. The method of claim 12 wherein said processing the light measurements comprises compensating for changes in hydration level of the biological tissue.
 14. An apparatus for measuring blood constituent concentration of a human or animal subject comprising: at least one light source for providing a sample beam and a reference beam, the at least one light source providing at least one wavelength of light, the at least one light source configured to direct the sample beam to tissue of the subject; a phase shifter configured to adjust the phase path of the reference beam; a scanner to scan the sample beam over a two-dimensional area of the subject's tissue; an interferometer to constructively interfere a reflected sample beam from the subject tissue with the reference beam; at least one photodetector to detect the interfered light; and a processor to calculate blood constituent concentration based at least partly on non-image measurements of the detected interfered light.
 15. The apparatus of claim 14 wherein the at least one light source comprises a low coherence source.
 16. The apparatus of claim 14, wherein the interferometer comprises a low coherence interferometer.
 17. The apparatus of claim 14 further comprising: a beam splitter to split light from the at least one light source into the sample beam and the reference beam; wherein the phase shifter is configured to direct the reference beam to interfere with the reflected sample beam.
 18. The apparatus of claim 17 wherein the beam splitter comprises a 2×2 optical splitter.
 19. The apparatus of claim 14 wherein the phase shifter comprises an adjustable reflector.
 20. The apparatus of claim 19 wherein the reflector is configured to scan multiple depths within the subject tissue.
 21. The apparatus of claim 14 wherein the photodetector comprises a photodiode.
 22. The apparatus of claim 14 wherein the at least one light source comprises a light emitting diode (LED).
 23. The apparatus of claim 14 wherein the at least one light source comprises a superluminescent diode (SLED).
 24. The apparatus of claim 14 wherein the scanner comprises a movable lenslet array which can be translated or rotated rapidly to reduce speckle.
 25. The apparatus of claim 14 wherein the scanner comprises a movable diffractive optical element which can be translated or rotated rapidly to reduce speckle.
 26. The apparatus of claim 14 wherein the scanner is configured to scan the sample beam such that the two-dimensional area is aligned with a skin surface.
 27. The apparatus of claim 14 wherein the scanner is configured to scan the sample beam to reduce speckle.
 28. The apparatus of claim 14 wherein the apparatus is configured to produce non-imaged interfered light. 